Impact of legal protections on the public health workforce's willingness to respond during emergencies

Effective response to public health emergencies is predicated not only on the public health workforce's ability to respond, but on its willingness to do so. Research points to major gaps in response willingness among vital occupational cohorts within the public health system, including the local public health workforce. We hypothesized that certain state-level legal protections--which do not currently exist--might influence public health workers' willingness to respond (WTR) during emergencies. With funding from the Robert Wood Johnson Foundation's Public Health Services and Systems Research program, we surveyed approximately 1,100 public health workers in over 22 health departments across three states regarding their WTR to four representative disaster scenarios within the all-hazards spectrum, given the presence of the following legal protections: 1) laws granting preferential access to health care for dependents during and after an emergency; 2) laws guaranteeing access to mental health services for those who participate in an emergency response; and 3) laws requiring the provision of personal protective equipment as part of an individual's response duties. After adjusting for demographics, the presence of the above legal protections was associated with a 5- to 20-fold increase in the odds of WTR across the four disaster scenarios (all p<0.05). We will discuss the implications of these findings for state-level legal reforms intended to address contemporary preparedness challenges. This presentation is intended for audiences with and without legal expertise.